Intravenous Infusion for Pain and Fatigue/Fibromyalgia

By William Rollow, MD

In January 2014, we began a new clinical service – the use of intravenous micronutrients (calcium, magnesium, trace minerals, Vitamin C, and B vitamins) for patients with pain and fatigue.  This therapy has been used for decades, and was popularized by a Baltimore physician named John Myers.

Micronutrients are vitamins and minerals that the human body requires in small quantities to efficiently operate basic functions of your metabolism.  A deficit of certain micronutrients can alter the metabolism and result in dysfunctions that may result in pain and fatigue.  Such deficits may not show up on standard blood tests.

Micronutrients are present in the diet, but sometimes are not well-absorbed, and giving them as supplements may upset digestion.  Furthermore, oral intake of micronutrients may not result in blood levels that are high enough to correct deficiencies.  Intravenous infusion can raise the blood levels of these substances directly and push them rapidly into cells where they can impact metabolism.

There are many anecdotal reports of the benefits of IV micronutrient infusion in patients with pain and fatigue/fibromyalgia.  There are also some published studies, including one controlled trial, in which symptomatic improvement was achieved.  A reference list can be found below.  We view this therapy as potentially useful in conjunction with other treatments, including dietary changes, herbal therapies, mind-body techniques, regular exercise, and more.

Insurance does not generally cover this treatment, so we offer it as a self-pay service for which we will provide a receipt that includes diagnosis and treatment codes that you can submit to your health plan.  The charge for the treatment is $140.  You can expect to need to do at least two or three infusions, at weekly intervals, before being able to determine whether the therapy is helpful to you.  If it helps, we’ll schedule a couple of additional infusions before reducing their frequency of administration.

Chronic pain and chronic fatigue can be helped by a variety of therapies, and we believe that micronutrient infusion has a place in the treatment approach.  We will be collecting self-reported data on its impact to support learning and research in this area.

For more information or to schedule an appointment, please call the University of Maryland Center for Integrative Medicine Clinic at 410-448-6361 or email CIMClinicInfo@som.umaryland.edu.

References:
1. Harakeh S, Jariwalla RJ, Pauling L. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells. Proc Natl Acad Sci U S A 1990;87:7245-7249.
2. Okayama H, Aikawa T, Okayama M, et al. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076-1078.
3. Sydow M, Crozier TA, Zielmann S, et al. High-dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus. Intensive Care Med 1993;19:467- 471.
4. Gaby AR. Intravenous nutrition therapy: the “myers’ cocktail.” Alt Med Review 2002;7(5):389-403.  
5. Ali M. Intravenous Nutrient Protocols for Chronic Fatigue States. The Canary and Chronic Fatigue. 
6. Reed JC. Magnesium therapy in musculoskeletal pain syndromes — retrospective review of clinical results. Magnes Trace Elem 1990;9:330. 
7. Ali A, et al. Intravenous Micronutrient Therapy (Myers’ Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study. J Alt & Comp Med. Vol 15.3. p247-257.
8. Massey PB. Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial. Alternative Therapies 2007;13(3):32-34. (14*)
9. Consumer Alerts: Myers’ Cocktail. Fibromyalgia Network. Retrieved July 23, 2013, from, http://fmnetnews.iraherman.com/coping-resources/consumer-alerts/product-8
10. Shealy CN, Cady RK, Veehoff D, et al. Magnesium deficiency in depression and chronic pain. Magnes Trace Elem 1990;9:333.  
11. Hauser RA, Lyons KE, McClain T, Carter S, Perlmutter D. Randomized, double-blind, pilot evaluation of intravenous glutathione in parkinson’s disease. Movement Disorders 2009;24(7):979-983.  
12. Sechi GianPietro, Maria G. Deledda, Guido Bua, Wanda M. Satta, Giovanni A. Deiana, Giovanni M. Pes, and Giulio Rosati: Reduced intravenous glutathione in the treatment of early Parkinson’s Disease. Prog. Neuro-Psychopharmacol & Biol. Psychiat.1996;20:1159-1170.
13. Dyckner T, Wester PO. Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment. Am Heart J 1979;97:12-18.
14. (2013, April 13). Myers’ (Intravenous) Cocktail. Hyperemesis Education & Research. Retrieved July 22, 2013 from http://www.helpher.org/health-professionals/myers-cocktail.php. 
15. Selby, J. (2009, April 3). Glutathione Therapy- An Interview with Dr. Perlmutter [Web log post]. Retrieved July 22, 2013, from http://thenaturalhealthguide.com.au/reviews/lifewave-glutathione-therapy/. 

Dietitian’s Recipe of the Week: Winter Minestrone

   

Serves 6

Ingredients

            2tbsp olive oil                            2 celery stalks, chopped

            2 carrots, chopped                   2 cup Swiss chard, chopped

            1 sweet potato, cubed             15oz can cannellini beans, rinsed and drained

            1 onion, chopped                      2 garlic cloves, minced

            14.5 oz can diced tomatoes    2, 14oz can low-sodium organic vegetable broth

            2 fresh rosemary sprits            ¼ cup flat leaf parsley, chopped

            Parmesan cheese, grated       Salt and pepper to taste

Directions

Heat oil over medium heat in a Dutch oven. Add onions, carrots, potato, celery, and garlic and cook for 10 minutes, stirring frequently. Add Swiss chard, salt and pepper and cook for 2minutes. Stir in tomatos and rosemary sprig. Bring mixture to a boil, and then reduce to a simmer and cook for another 10minutes. Meanwhile, blend ¾ of the beans with ½ cup of broth in a food processor or blender. Add pureed beans and remaining broth to the vegetable mixture and simmer for about 15minutes. Stir in the remaining beans and parsley. Discard rosemary stems and season with salt and pepper to taste. Serve soup with grated parmesan cheese on top.

Nutrition facts (per serving): 270calories, 5g fat, 34g carbohydrate, 7.5g fiber, 9g protein 

Chronic Inflammation: The Importance of Dietary Changes

By Erin Peisach, RD, LDN and William Rollow, MD

In the past month, we have seen many patients in our clinical practice who presented with a variety of symptoms, including pain, lack of energy, nausea, and irritability.  In conventional medicine, these symptoms often are evaluated independently with diagnostic tests for specific diseases, and many such patients have hypertension, diabetes, heart disease, migraines, etc.  In an integrative approach, we look at the whole person and for underlying issues that are capable of affecting multiple organ systems.  As a result of the comprehensive assessment, many times we suspect that the person has triggered a chronic inflammatory state.  

Inflammation is the process by which the body protects and heals itself in response to infectious, traumatic, or toxic insults.  Acute inflammation can be highly beneficial and necessary, although it may cause symptoms that are unpleasant—pain, swelling, fever, etc.  When the inflammation becomes chronic, however, these and related symptoms also become chronic, and the inflammation may contribute to the development of cardiovascular disease, arthritis, and other chronic illnesses.

Chronic inflammation results from persistence of the initial insult (e.g., infection or toxicity), but are also highly influenced by dietary and lifestyle factors.  Diet promotes chronic inflammation in several ways:
     • Sugar or high glycemic foods increase insulin and lead to obesity; fat cells make inflammatory             mediators
     • Saturated fats or inadequate intake of omega 3 fats promote inflammation
     • Foods that one is sensitive to, or that leak through the intestinal wall into the bloodstream                   cause inflammatory reactions 

In addition to diet, chronic stress, lack of physical activity, and poor sleep are controllable lifestyle factors that negatively impact the body’s inflammatory response.  Here are some tips to heal and prevent chronic inflammation in your body:

Work it out:  Exercise can be helpful in managing stress, improving sleep quality, and burning calories to promote weight loss.   150 minutes of moderate intensity exercise per week is recommended for those who have no medical contraindications.

Shop the perimeter:  Consuming a diet with excessive amounts of sugar and simple carbohydrates, hydrogenated and damaged oils, caffeine, and alcohol also promote chronic inflammation.  Purchasing from the perimeter of the grocery store is one useful strategy for avoidance—most packaged and shelf-stable foods found in the aisles of the grocery store contain potentially harmful ingredients. Conversely, food that comes from the produce, meat, seafood, deli, and dairy departments typically provides more nutrient-dense, less processed options. 

Embrace an “anti-inflammatory diet”:  Not only is it vital to avoid foods that cause inflammation, but it is also important to consume adequate anti-inflammatory foods and nutrients. Consume adequate omega 3 fatty acids from foods like wild salmon, sardines, chia seeds, and hemp seeds. Monounsaturated fatty acids from avocados, cold-pressed extra virgin olive oil, and macadamia nut oil are also important to control inflammation.  Consume a variety of organic, local and fresh vegetables and fruits such as dark leafy greens, berries, and cruciferous vegetables.  Eating at least 6 to 12-cups per day ensures the diet is plentiful in fiber, vitamins, minerals, and antioxidants. Cook your food with herbs and spices like ginger, rosemary, and turmeric to additionally boost its anti-inflammatory power. Lastly, it is crucial to identify and eliminate all foods that may promote an adverse food reaction (i.e. allergy, sensitivity, or intolerance). Common trigger foods include dairy, gluten, soy, and peanuts. 

One small change at a time:  Whether you “feel it” or not, inflammation is occurring inside us all. Making just one small change at a time will help you to achieve long, lasting change in the long run. Pick one aspect of your life that may cause inflammation and make a change today. Add in an extra vegetable serving at dinner to replace the usual starch.  Go to bed an extra hour early so you can attain at least 7-hours of sleep. Use garlic and rosemary on your chicken at dinner time and place it on top of a bed of spinach.  

Making changes can be hard, but they can have huge benefits for people with chronic inflammatory diseases.  The University of Maryland School of Medicine Center for Integrative Medicine clinic specializes in helping people make healthy changes.  To get help, talk with a practitioner or make an appointment directly with Erin Peisach, the clinic’s Registered Dietitian, by calling 410-448-6361 or emailing CIMClinicInfo@som.umaryland.edu.